Governor Gavin Newsom has long been a vocal supporter of extending health care access to undocumented immigrants, describing the expansion of health insurance and other health care programs as “the California way” in his 2022 State of the State address. Medi-Cal has steadily expanded to undocumented people during Newsom’s administration, starting with children in 2016, to young adults in 2020, to people 50 and older in 2022, and all remaining adults this year.
That’s why some advocates and researchers were caught off guard by a cut Newsom proposed to address the state’s funding shortfall: removing elderly and disabled undocumented immigrants from a program designed to help people live outside of nursing home care. The benefit, run by the California Department of Social Services, has only recently been made available to people without legal residency through the expansion of Medi-Cal.
On May 10, Newsom announced that California faces a $27.6 billion shortfall in the next fiscal year. Among the many cuts to public benefits proposed by the governor, In-Home Supportive Services is the only one that may see a group of people removed based on their immigration status.
Through the program, elderly, blind or disabled individuals who would likely need nursing facility care can instead stay home with the assistance of a hired care provider, often a family member, whose hours are paid for by the program. The care providers offer help with chores and personal care needs like bathing, feeding and transportation.
“It’s very upsetting to see that in the first instance of financial trouble we’re looking at targeting undocumented people for budget cuts,” says Hagar Dickman, Senior Attorney at Justice in Aging, a national advocacy organization that uses litigation to combat senior poverty.
The Governor’s office did not respond to multiple requests for comment.
The Department of Social Services is working closely with the Department of Health Care Services, the agency that runs Medi-Cal, “to mitigate any negative impacts to currently assisted individuals including looking at other benefits they may be able to receive under the Medi-Cal program,” said Claire Ramsey, the Department of Social Services Chief Deputy Director, at a May 20 Senate Health and Human Services Subcommittee hearing.
On May 30, the Senate subcommittee and the Assembly Budget Committee rejected the Governor’s proposal to remove undocumented immigrants from in-home support services. Immigrant advocates applauded the move, but the issue is not settled. Two weeks of negotiations remain before the houses pass a final budget by June 15.
How many people would be impacted by cuts to In-Home Supportive Services?
It remains unclear how much money would be saved and how many people would be affected by the cuts, says Shannon McConville, Senior Fellow at the Public Policy Institute of California, a nonpartisan research organization. Different agencies, she points out, have published discrepancies in data on in-home services to undocumented people.
The Newsom administration estimates that the move would save the state $94 million, but doesn’t clarify how many people would be removed from the program.
The Department of Social Services estimated at the hearing on May 20 that nearly 3,000 people might be dropped from in-home care and had previously projected that nearly 1,500 undocumented immigrants age 50 and older received in-home services monthly in the last fiscal year.
However, the Legislative Analyst’s Office (LAO), the nonpartisan fiscal and policy advisor to the California Legislature, had estimated that 34,000 undocumented people 50 and over would enter IHSS last year. The state’s budget of more than $900 million was meant to cover the anticipated expansion, according to the LAO. “That doesn’t align at all with what the May Revision says they are saving,” McConville says.
Juwan Trotter, Fiscal Policy Analyst at the LAO, said in an emailed statement that they are still working with the administration to better understand how many people would be affected by this proposal, and that they are waiting for the release of legislative language for further clarity.
California legislators have until June 15 to pass a budget. In the meantime, the lack of clarity has left researchers like McConville and advocates like Dickman questioning how much of an effect this cut would have on the state’s budget and on the lives of those who would be removed from the program.
The figures provided by the Department of Social Services may not include people who are actively trying to obtain IHSS benefits, Dickman says, possibly accounting for some of the discrepancy.
“Getting onto the IHSS program has a lot of administrative burdens,” Dickman says. The group that might be hardest-hit by cuts to IHSS are undocumented immigrants over the age of 50, the same people who might still be struggling to work through the application process.
Public Charge
Advocates have raised concerns that removing in-home care as a benefit to undocumented people could put them at risk of becoming a public charge. People who are undocumented but are on a pathway to a visa or an adjustment of status must establish that they will not become dependent on some types of governmental assistance, in other words, a public charge.
Medi-Cal benefits such as in-home care are not subject to public charge rules, meaning undocumented immigrants who receive them won’t risk damaging their applications for their residency or citizenship.
However, some advocates have expressed concern that people removed from in-home care might seek other benefits that do put them at risk of becoming a public charge.
“They might be in a nursing care facility instead, and so there are some public charge implications there,” says Linda Nguy, Associate Director of Policy Advocacy at the Western Center on Law and Poverty, a legal advocacy organization that is also considering bringing litigation should California move forward with the cuts.
At the May 20 Senate Subcommittee hearing, legislatures asked officials from the Department of Social Security about the public charge issue.
Ramsey, the department’s Chief Deputy Director, responded by saying she would take the question back to the agency. “We are cognizant that people may need to make hard choices if the proposal goes forward,” she added.
Justice in Aging and the Western Center on Law and Poverty are two of the 133 organizations that have signed onto a May 20 letter urging the Administration not to remove undocumented immigrants from the in-home care program.
During the subcommittee hearing, more than 20 people stood to voice opposition to the proposal during a public comment period. Among them was Warren Cushman, a community organizer at Community Resources for Independent Living, a disability resource organization in Hayward.
“[The] discussion today around the undocumented population is just shocking,” he said. “The fact that we would in our state consider that—consider cutting off an entire group of folks from [in-home care], that would just be unconscionable.”
